Patient Protection, Affordable Care, and Accountable Design

Article excerpt

Introduction

In this issue oí Frontiers, Craig Beale, FACHE, and Frank D. Kittredge Jr., FACHE, offer a view of current trends in healthcare facility design, while Michael H. Covert, FACHE, describes Palomar Health's experience in envisioning the hospital of the future. While each considers facility design from a different spectrum of care (ambulatory and inpatient), they touch on several common themes:

* Knowing your market

* Incorporating flexibility and adaptability in an era of rapid change

* Bringing in outside points of view to drive innovation

* Striving for sustainability, for those using the building and the surrounding community

* Linking facility design to a variety of improved outcomes

* Practicing consumer-focused healthcare

These themes align with numerous other recent projects that help to build a rich story surrounding the impact of healthcare facility environments-an area many take as a "given." Understanding these similarities is increasingly important in an ever-changing landscape of healthcare reform where organizations are reimbursed for value rather than volume and are taking increasing responsibility for the health and wellness of the communities they serve.

So what is the real role of facility design in the increasing drive for reduced costs and improved outcomes in the healthcare reform conversation? Is it the design elements that we seek to understand and quantify? While the feature authors address some implications of these themes in facility design, a continuing shortfall in many projects is an effective integration of the interactions of people, operational policies and procedures, and the built environment in order to optimize the performance of a complex system. Should the underlying processes (for both design and operations) be considered more proactively?

Facility Design and Outcomes

Certainly the link between facility design and outcomes is no longer a new concept in healthcare. Roger Ulrich's seminal study about views of nature published in 1984 captured national attention and became a springboard for advancing the discussion about design and healing. Frontiers published another groundbreaking report by Leonard Berry and his colleagues in 2004 that centered on the creation of Fable Hospital, a hypothetical facility based on consolidating outcomes from several of the Center for Health Design's Pebble Partners.1 The idea of Fable Hospital was to start a conversation about facility design and return on investment through improved outcomes. In that same year, a literature review found more than 600 studies linking design features to patient and staff outcomes in healthcare facilities (Ulrich et al. 2004).

But the body of knowledge continues to grow, and in 2008, an update of the 2004 literature review found more than 1,000 such studies (Ulrich et al. 2008). Today, the Center for Health Design houses more than 3,000 references in its Knowledge Repository (www.healthdesign.org/search/ articles) to aid healthcare administrators and designers in their decision-making process. The practice of evidence-based design for healthcare facilities, similar to evidence-based practice in medicine, has become mainstream in the past decade. Identifying Design Interventions and Outcomes

At Palomar Health, one of the Center for Health Design's Pebble Partners, this knowledge base of information was used to develop concepts that aligned with the design principles of the project. The organization focused on several specific design interventions to improve outcomes, such as acuity-adaptable rooms to reduce patient transfers (and the potential for handoff errors), same-handed room layouts so staff always know where items are located (and to reduce error through standardization and improve safety in urgent situations), and space for families (to encourage engagement in their care). Decentralization was cited by Covert for its improved impact on visibility, number of patient calls, and noise levels. …